HomeMy WebLinkAbout0106 ~
Deci~rati~n ot ~c~rmi~~ls anci Citiz+engt~ip ~
TO TNE STATE AND COUNTY TAX ASSESSOR,
i_~~ 1_a`.)`..~
Sl. IUCIE COUNTY, FLORI~A:
?his is my declaration of Dornic~;e and Citizenship in the State of Florida that I am filing this day in accordance and
in conf~rmity with Chapter 222, Section 222.17, Florida Statufes.
I was farme~ly a legal resident of ____S~~ ~8rit1988Ae
- - - Y - - .
(Cit ) (State)
and I resided at -~ute - _ However I have changed my domiCile
(Street and Number)
lq '
to and am and have been a bona fide resident of the State of Florida since day of
Deae~sber 65 71Z Azalia Avenue
- 19----, and I reside at -
(Street and Number)
FORT PIERCE, SAINT LIICIE COUNTY, FLC~RIDA
and th~s statement is io be taken as my declaration of citizenship, actual lega) resic~ence and domici!e in ihe State of Florida. ~
~
i
(Insert here any pertir~ent facfis, such as sale of property or business, or relinquishment of employment ~
at former domicile, removal of family to new d~micile, purchase of home, etc.)
;
~
~
,
D ~~R ~o K
~ ~~~0 AN ~
~
.
. `4' ~6
~n~ering txo chi'k1 ren in first grad~ ~ 4~ 3a p~ ~~J~~~`3
65 ~ 1- .
',:i tti`+'~~,K
~~c~i.,~-'~ ~k~~'~~-~. ,
F - ; .
- 1
~ " . . . ~ - ~
_ - ,
I FURTHER CERTIFY that I wit) comply with all other requirements of a lega) resident of this Stafie. ~
~
F I FURTh9ER CERTIFY that I have no intention to return to my former domiCi~e, and I intend to remain in FORT
f ~
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
i; c2 ~
. ~ ~ . . - ~ (Name)
_ , ~j~'~-d
_ . , ~ - - . ~&ba~Odf~`ey
. ' ' . ~ ~ ' - (Address)
, . ~ - • - ~ . ~ 30 December q 65 ~
' ,,~worK to and~ subscribed before me this day of - , 1 ,
, . ~
:
~
ROGER POITR~?S ~
LERK CIR !!!T COUR Notary Public
gy D.C. My Commission expires
(Ta be executed in duplicate and origina) filed with Clerk Circuit Court, and duplicate with Tsx Assessor.)
' BOOK~~~ ~o~ ~ ~